Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Br J Ophthalmol. 2013 Apr;97(4):429-32. doi: 10.1136/bjophthalmol-2012-302251. Epub 2013 Jan 23.
To determine whether initial empiric treatment of cases with Pseudomonas aeruginosa contact lens-associated keratitis (CLAK) with chloramphenicol had an adverse effect on outcome.
We retrospectively reviewed 139 cases of culture-proven P. aeruginosa CLAK seen between 2007 and 2009. We recorded chloramphenicol use prior to the prescription of a fluoroquinolone, the visual acuity (VA) when the fluoroquinolone was started and at final follow-up, complications and duration of follow-up.
46 patients (33.1%) had used chloramphenicol before they were prescribed a fluoroquinolone. When we compared this group with patients who had initial treatment with a fluoroquinolone, the ulcer size was larger when a fluoroquinolone was started (Mann-Whitney, p=0.018). Although the initial VA was also worse in the chloramphenicol group (p=0.02), and complications more frequent (p=0.016), the final VA in both groups was similar (p=0.29). The chloramphenicol group had a longer median follow-up of 37 days (IQR: 9-310 days) compared with 21 days (IQR: 6-80 days) for the non-chloramphenicol group (p=0.09).
Chloramphenicol 0.5% eye drops are available in the UK without prescription. Chloramphenicol had been used in one-third of cases of P. aeruginosa CLAK prior to the use of a broad-spectrum antimicrobial, which was associated with more complications and a longer interval to resolution, but with no adverse effect on final VA.
确定铜绿假单胞菌接触镜相关性角膜炎(CLAK)患者初始经验性治疗中使用氯霉素是否对结局产生不利影响。
我们回顾性分析了 2007 年至 2009 年间确诊的 139 例铜绿假单胞菌 CLAK 病例。我们记录了在开氟喹诺酮之前使用氯霉素的情况、开始使用氟喹诺酮时和最终随访时的视力(VA)、并发症和随访时间。
46 例(33.1%)患者在开氟喹诺酮之前使用了氯霉素。与初始使用氟喹诺酮的患者相比,当我们开始使用氟喹诺酮时,该组的溃疡面积更大(Mann-Whitney,p=0.018)。尽管氯霉素组的初始 VA 也较差(p=0.02),并发症更常见(p=0.016),但两组的最终 VA 相似(p=0.29)。氯霉素组的中位随访时间为 37 天(IQR:9-310 天),而非氯霉素组为 21 天(IQR:6-80 天)(p=0.09)。
氯霉素 0.5%滴眼剂在英国无需处方即可获得。在使用广谱抗菌药物之前,三分之一的铜绿假单胞菌 CLAK 病例使用了氯霉素,这与更多的并发症和更长的缓解间隔相关,但对最终 VA 没有不利影响。